INFORMATION DOMAINS FOR USE WITH THE WISCONSIN STAR METHOD

Transcription

1 INFORMATION DOMAINS FOR USE WITH THE WISCONSIN STAR METHOD INFORMATION HELPFUL TO GATHER AS FEASIBLE, BUT NOT REQUIRED Timothy Howell MD, MA Version Disclaimer: The Wisconsin Star Method is published in the public domain, and as such may not be copyrighted, trademarked or patented. Permission is granted to use, reproduce and or adapt the Wisconsin Star Method provided this Disclaimer is included in any and all such materials, including the following acknowledgement: The Madison Veterans Administration Hospital, the University of Wisconsin Madison School of Medicine and Public Health, the Division of Mental Health and Substance Abuse Services of the Wisconsin Department of Health Services, NAMI Wisconsin, and members of the Wisconsin Geriatric Psychiatry Initiative have provided in kind support for the development of the Wisconsin Star Method.

2 I. MEDICATIONS: Prescribed: OTC: Borrowed/leftover: Adverse drug reactions: II. MEDICAL FACTORS: Diagnoses: Symptoms: Functional status: ADLs: IADLs:

3 III. SOCIAL FACTORS: Primary support: Social environment: Activities: Economic: Housing: Transportation: Legal: Other: IV. BEHAVIORAL FACTORS: Diagnoses: Symptoms: Functional status: Short term memory: Long term memory: Expressive language: Receptive language (understanding): Visual (agnosia): Psychomotor (apraxia): Executive functions: see also IADLs

4 EXECUTIVE FUNCTIONS : how effective are the person s abilities to do the following 1. Attention: sustaining awareness 2. Response inhibition: blocking distractions in order to stay focused 3. Working memory: keeping a number of things in mind at the same time 4. Planning: Sense of the future: vs. primarily/exclusively in the present Generation/selection of options 5. Abstract thinking: vs. concrete 6. Implementing plans: Deciding: vs. indecisive Starting: initiating (like engaging clutch in car) when motivated Sustaining: staying on task & finishing for short duration: extended duration: Stopping: vs. perseverating 7. Set shifting: flexibility vs. getting stuck 8. Organization: Categorizing: Sequencing: correct order of steps in multi step task 9. Multi tasking : ability to divide attention between simultaneous tasks 10. Problem solving: familiar : new (not previously encountered) : 11. Monitoring: Awareness of self: listening to & understanding how you perceive/feel/think/act Awareness of others: listening to & understanding how others perceive/feel/think/act 12. Evaluation/judgment: vs. unwarranted/incorrect/inappropriate for the situation 13. Modulation of Perceptions: modifying views vs. automatic stereotyping 14. Modulation of Feelings: vs. lability of affect 15. Modulation of Emotions: vs. ineffective mood states (e.g. carrying an unwarranted grudge) 16. Modulation of Behavior: vs. disinhibited or overly inhibited actions

5 17. Modulation of Ego: Internal: vs. self esteem too high or too low Interpersonal: vs. being too selfish or too selfless V. PERSONAL FACTORS: Factors to explore when hypothesizing about possible meanings of behaviors 1. Knowledge: General: facts, methods/procedures, cultural (e.g. customs), literacy Specific: to issues at hand (e.g. in Most Difficult Case Conference), health literacy Prior experiences: relevant to these issues (e.g. wonderful, traumatic) Education: 2. Values: General: e.g. kindness; (also, those implicit in traits; see V.5 below) Specific: e.g. favorite activities, possessions, books, songs, TV shows 3. Loyalties: Self: Family Nuclear: Extended: Friends: Groups (e.g. organizations): Planet (e.g. local or global ecology): Others: 4. Rules of thumb: principles that guide behavior (e.g. golden rule, tit for tat ) Conscious: able to be explained verbally by user (e.g. when X, do Y ): Automatic: Not usually thought about when used (e.g. driving on right side of road): Learned and not accessible to consciousness (e.g. intuitions; gut feelings):

6 5. Personality traits: degrees of intensity/flexibility & context specific vulnerabilities to stress (underlying anxieties) Dependent: sensitivity to lack of support (fear of abandonment) Independent/self reliant: sensitivity to relying on others (fear of dependence) Conscientious: sensitivity to rules, obligations (fear of irresponsibility/incompetence) Autonomous: sensitivity to self determination (fear of loss of being in control) Dramatic: sensitivity to being attractive (fear of being rejected) Avoidant: sensitivity to acceptance vs. criticism, rejection Narcissistic: sensitivity to status, entitlement (fear of loss of status, power) Suspicious: sensitivity to harm (fear of being exploited, injured) Meticulous: sensitivity to order (fear of disorder) Empathic: sensitivity to others thoughts, emotions, actions Openness to experience: sensitivity to novelty, ambiguity (fear of unpredictability) Others: e.g. altruistic, thrifty, brave, agreeable, generous, conscientious, meticulous, etc. COPING STRATEGIES : Characteristic ways of managing stress that emerge from interactions between factors V.1 5 Effectiveness of any one strategy determined by specific context What are the person s usual ways of coping in various situations? Intellectualize Deny Distract Minimize Self blame Withdraw Disown (externalize) Resign Dissolve (e.g. in substances) Suppress Redefine Share

7 Adhere/comply Address Negotiate Other CLINICAL WISDOM : Perceptual/Cognitive/Emotional/Behavioral Effectiveness of Systems, Organizations, Teams, & Their Members Awareness: attending to relevant knowledge, perceptions/feelings/emotions, values, loyalties, rules of thumb, & personality traits (one s own and others ) Response inhibition: taking time to reflect, avoiding premature closure and impulsive reactions; not taking things personally Reflection: External considering circumstances; identifying how factors may be interacting; connecting the dots ; recognizing patterns Internal listening to how one feels; thinking about how one is thinking; reflecting on one s perceptions Pragmatic knowledge: knowing what to do, and knowing when, where, how, and why to apply that knowledge Tolerance of ambiguity: able to appreciate/address uncertainties when diagnostic, therapeutic and prognostic issues are unclear/complex Non judgmental: willing to examine situations from multiple different perspectives, to respect/honor differences, and to establish/sustain collaborative relationships (e.g. by agreeing to disagree) Openness to new perspectives, knowledge, experiences and methods; curiosity Understanding: of anxieties (overt and underlying) driving behaviors Modulated responsiveness: cognitive and emotional resilience Integration of: emotional sensitivity and cognitive objectivity cognitive sensitivity & emotional objectivity Ego modulation: commitment to the common good; focus on effective outcomes for patient/family/team/organization/system, as well as for oneself